198603580-11-28-2023-28-AS-RORN-D27QSH-20240206112532

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603580
Report Date: 11/28/2023
Date Signed: 11/28/2023 03:08:30 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/07/2023 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230407155557

FACILITY NAME:	BEVERLY HILLS SENIOR CARE		FACILITY NUMBER:	198603580
ADMINISTRATOR:	DUFRENNE, PATRIA M.		FACILITY TYPE:	740
ADDRESS:	1015 S. ORANGE GROVE AVE		TELEPHONE:	(323) 933-8271
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90019
CAPACITY:	45	CENSUS: 44	DATE:	11/28/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Dana Ordonez		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff do not meet resident's incontinence needs
Staff spoke inappropriately to resident
Staff did not provide resident with clean linen
Staff do not assist resident with showering

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced subsequent complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Administrator Dana Ordonez and explained the reason for the visit.

The investigation consisted of: During the initial visit conducted on 04/13/23, LPA Gonzalez conducted interviews with Administrator Patria Dufrenne, S1 and R1-5. LPA reviewed R1-5 files. LPA collected copies of Staff/ Resident Rosters and copies of pertinent documents related to complaint allegations. LPA also conducted a tour of the facility inside and out including facility medication room, dining rooms located on the 1st and 2nd floors, and inspection of the following resident rooms: 103, 104, 105, 106, and 108. On 11/28/23, LPA interviewed Administrator Dana Ordonez, and S2-4. LPA reviewed R1's facility file and

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 11/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230407155557

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BEVERLY HILLS SENIOR CARE	FACILITY NUMBER: 198603580
	VISIT DATE: 11/28/2023

NARRATIVE

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collected copies of various documents pertinent to the investigation. LPA conducted a tour of facility including lobby, dining room, common areas on both 1st and 2nd floor, laundry room and a random selection of resident rooms. LPA collected copies of Staff and Resident Rosters. LPA also conducted a phone interview with R1's home health agency and requested copies of home health care documentation.

Investigation revealed the following: Regarding allegation, Staff spoke inappropriately to resident, it is alleged that a facility staff (S1) spoke to a facility resident (R1) inappropriately. R1 allegedly "confronted" S1 about not being changed during the night and S1 allegedly told R1 that they "did their job and did not want to hear about it anymore." Interviews conducted with facility staff revealed that staff do not speak to residents inappropriately and that staff treat all facility residents with dignity and respect. S1 stated that they never told R1 a statement like "I did my job and I don't want to hear about it anymore." S1 stated that they have never spoke to R1 or any other resident inappropriately. 5 out of 5 residents stated that staff do not speak to them inappropriately. R1 denied that S1 spoke to them inappropriately. Based on interviews conducted with residents, all residents stated they are treated with dignity and have been not mistreated by any of the staff. LPA observed staff interacting with residents during the visits conducted on 04/13/23 and 11/28/23 and did not observe anything of concern. Based on interviews conducted with staff, residents and LPAs observations there was not enough supportive evidence to concur with the reported allegation.

For allegations, Staff do not meet resident's incontinence needs and Staff did not provide resident with clean linen, it is alleged that R1 was observed to be laying in urine and that R1's bed linens were soaked in urine and had feces in their diaper and had not been changed. Interview conducted with Administrator Patria Dufrenne, and facility staff revealed that residents linens are cleaned on a daily basis and as needed depending if a resident has had an accident. Administrators stated that R1 is seen by a home health nurse approximately 1-2 times a month for catheter care and that staff tend to R1's other needs as needed throughout the day and night on a daily basis. Administrator Dufrenne stated that R1 is checked on every two hours and denied that R1 was ever found laying in urine with feces in their diaper. She stated that if R1 happened to have been observed with urine and feces in diaper it might have just happened and staff had not gotten to the resident yet. She stated that R1 uses the pull cord when they need assistance and staff immediately tend to the resident needs. Staff stated that there are some residents that require assistance with Activities of Daily Living (ADLs) and that staff tend to them immediately when there has been an accident. They stated that every resident has a call button and staff respond to an alert immediately to check

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 11/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230407155557

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BEVERLY HILLS SENIOR CARE	FACILITY NUMBER: 198603580
	VISIT DATE: 11/28/2023

NARRATIVE

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on residents and tend to their needs. S1-4 stated that that staff immediately respond when a resident pushes their call button and stated that residents are not made to wait for long periods of time. S1-4 denied that any resident has ever been left in soiled linens or not changed for an extended period of time. They stated that if a resident has had an accident the longest a resident will wait is from the time a resident pushes the call button to when the staff reaches the resident in their room. They stated that it will only be 2-5 minutes and not longer than that. Staff stated that if a resident happens to not use a call button they are constantly conducting rounds and checking in on residents to see if they need any assistance or help with anything. Staff stated that resident's laundry is done twice a week and as needed. 4 out of 5 residents stated that their linens are cleaned daily and their laundry is done twice a week. 4 out of 5 residents stated that they are happy with the laundry services as well as all other services that they receive at the facility. 5 out of 5 residents stated that staff respond to a call button signal in an appropriate amount of time, they are never made to wait for long periods of time and stated that staff are very helpful at all times. R1 did not want to answer any questions regarding being observed to be laying in urine, bed linens soaked in urine or with feces in diaper. R1 stated that staff respond to a call button within 5 minutes and that staff check on them about every 2 hours throughout the night. R1 stated that sometimes they are sleeping so they do not know if staff check on them then. LPA observed staff assisting residents and did not observe anything of concern. LPA observed that the facility has a functioning call system in place. LPA toured the facility laundry room and observed that the facility has a washer and dryer as well as products needed to wash resident's clothes and linens. LPA did not observe any resident laying in urine and did not smell any strong odors such as urine or feces when touring the resident rooms or when interviewing facility residents. Based on LPAs observations, review of documents and statements gathered from interviews conducted with staff and residents there was not enough supportive evidence to concur with the reported allegation.

For allegation, Staff do not assist resident with showering, it is alleged that facility staff do not clean or shower a facility resident (R1) and the resident has not been showered in one month. Interviews conducted with Administrator Dufrenne, Administrator Ordonez and facility staff revealed that R1 and any resident that needs assistance with Activities of Daily Living (ADL's) are assisted by staff. Administrator Ordonez stated that R1 is showered twice a week and that all residents that need shower assistance are showered twice a week per an implemented shower schedule. Staff stated that facility staff do meet all resident's personal care and hygiene needs. They stated that residents are provided with proper hygiene products. Staff stated that they always shower residents that require assistance per their schedule and/ or if they had an accident, they will give residents an extra shower to make sure they are clean. They stated that if a resident refuses or asks

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 11/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230407155557

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BEVERLY HILLS SENIOR CARE	FACILITY NUMBER: 198603580
	VISIT DATE: 11/28/2023

NARRATIVE

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staff to come back at a later time, staff will ensure to go back and assist the resident(s) with their shower and if a resident refuses to shower it is properly documented. Staff stated that if a resident happens to have an accident in the middle of the night they are given a sponge bath and properly cleaned and then they will shower the resident in the morning. R1 did not want to answer any questions regarding being assisted by staff with showering or being cleaned by staff. 2 out of 5 residents stated they get showered twice a week and staff always give them a shower on their shower day. 2 residents stated that they are independent and do not require shower assistance and stated that the facility provides them with hygiene products. LPA reviewed shower schedule and observed that residents that receive assistance with showers are given a shower twice a week including R1. Based on LPA review of documents, interviews conducted with facility staff, and facility residents, there was not enough supportive evidence to concur with the reported allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held. A copy of the report was provided to Administrator Dana Ordonez.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 11/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023

LIC9099 (FAS) - (06/04)

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